| 李建成,王笑良,赵云辉.胸中下段食管癌肿瘤靶区内扩边范围的初步研究[J].肿瘤学杂志,2013,19(4):258-262. |
| 胸中下段食管癌肿瘤靶区内扩边范围的初步研究 |
| Internal Margin of Gross Tumor Volume of Thoracic Esophageal Cancer |
| 投稿时间：2012-04-25 |
| DOI：10.11735/j.issn.1671-170X.2013.04.B2012201 |
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| 中文关键词: 呼吸运动 食管肿瘤 肿瘤靶区 内靶区 |
| 英文关键词:respiratory movement esophageal neoplasms tumor target volume internal target volume |
| 基金项目:福建省卫生创新课题(2007-CX-4)；福建省临床重点专科建设项目（2012年）。 |
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| 中文摘要: |
| 摘 要:［目的］ 通过测量平静状态下吸气末与呼气末间胸段食管癌肿瘤靶区的位移，为临床提供胸段食管肿瘤靶区内扩边界的参考范围。［方法］ 以22例不能手术的胸中、下段食管癌患者为研究对象。16排螺旋CT在相同的条件下进行扫描，获取平静呼吸状态下吸气末及呼气末两个时相的CT图像，图像由计算机软件重建后，分别将图像传至核通OTP靶区勾画系统。根据人体在CT的坐标系统所形成的坐标获得食管肿瘤靶区位移、GTV的体积变化，并分析此变化与潮气量、肿瘤位置和肿瘤长度是否相关。根据肿瘤靶区位移的95%百分位数，作为食管胸中下段肿瘤靶区内扩边的参考范围。［结果］ 平均潮气量为463.6ml。GTV的平均体积：吸气末是33.3ml，呼气末是33.5ml，两组比较差异无统计学意义（t=-0.034，P＞0.05）。食管中下段肿瘤靶区内扩边范围分别为：（X轴方向）左界2.79mm、右界2.00mm，（Y轴方向）上界即朝头方向8.70mm、下界即朝脚方向11.21mm，（Z轴方向）前界4.47mm、后界 2.15mm。Pearson相关分析得出食管肿瘤靶区运动与患者的潮气量呈正相关（r=0.6，P＜0.05），与肿瘤位置、肿瘤长度无明显相关性（r=0.09和0.29，P=0.71和0.21）。但胸中下段食管肿瘤靶区位移在头、脚方向明显，尤其是朝脚的方向。［结论］ 因呼吸运动及周围器官运动可造成食管肿瘤靶区(GTV)在各个方向存在不同的位移。所以，建议临床上食管癌放疗计划靶区（PTV）的扩边应考虑每次放疗中呼吸运动及周围器官运动所致的位移。 |
| 英文摘要: |
| Abstract:［Purpose］ To approach the displacement of gross tumor volume (GTV) of thoracic esophageal cancer in calm sate of end-inspiratory and end-expiratory，and to provide the reference range of the internal margin of GTV of thoracic esophageal cancer for clinic. ［Methods］ Twenty-two patients with unresectable thoracic esophageal cancer were enrolled and treated with radiotherapy. The calm state images of end-inspiratory and end-expiratory CT were obtained by 16-slice spiral CT scanning. The relations of displacement and volume change GTV with tidal volume，location and length of tumor were analyzed. Percentile of 95% of GTV displacement was determined as the reference value of internal margin of gross tumor volume (IGTV). ［Results］ The average volume of GTV in end-inspiratory was 33.3ml，and in end-expiratory was 33.35ml without significant difference between them(t=-0.034，P＞0.05).Pearson analysis showed the motion of GTV positively related to the tidal volume of patients(r=0.6，P＜0.05)，which did not significantly correlate to tumor location and the length of tumor(r=0.09 and 0.29，P=0.71 and 0.21). However the displacement of the lower thoracic and the middle thoracic target volume in the direction of the head and feet were obvious，especially in the direction of the feet.［Conclusion］ Due to respiratory movement and organs’ movement，the displacement of GTV in esophageal cancer is different in all directions. It is recommended that the expansion of the planning target volume (PTV) in radiotherapy should take account of the displacement of the tumor target volume caused by respiratory movement and organs’ movement. |
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